          <div class="modal_window" id="modal_window_appt">
              <form class="modal_form" id="modal_form_appt">
              	<label class="header"><strong>Date & Time:</strong> <%= appointment.get("appointmentdate") %> at <%= appointment.get("appointmenttime") %></label>
              	<label><strong>You can select complain or type in the textbox below:</strong></label>
              	<select style="width: 90%;padding: 2px 8px;float: left;" id="selectProblemTemplate" >
				</select><br> 
				<label id="linked" style="display: none;"><strong>Here is some help on the selected problem. Click <span class="hypered">here </span> </strong></label><br><br>
                  <input id="complaint" type="text" placeholder="Type Chief Complaint..." style="width: 90%;float: left;"><br>
                  <label><strong>Is this a video conference request?:</strong></label><input id="videoconf" type="checkbox" value="Y">
                  <textarea id="otherdetails" rows="5" cols="70" placeholder="Type any other details you want to provide.." style="width:100%"></textarea ><br>
                  <div class="close actions" id="actions">
				<span class="fc-button fc-button-today ui-state-default ui-corner-left ui-corner-right">
					<span class="fc-button-inner">
						<span id="appointmentSubmit" class="fc-button-content">Submit</span>
						<span class="fc-button-effect">
							<span></span>
						</span>
					</span>
				</span>
                  </div>
              </form>
              <a  id="close_x" class="close close_x" href="#">close</a>
          </div>
          